Key result
eGFR equations perform as well as Cockcroft-Gault for assessing DOAC dosing in older AF patients.
Why the study?
Although the Cockcroft-Gault equation is recommended for DOAC dose adjustment, it was unknown whether defining dose appropriateness using different kidney function estimators altered associations with adverse events in older adults with AF.
Does defining DOAC dose appropriateness by eGFR equations compared to the Cockcroft-Gault equation change the association with adverse events in older adults with atrial fibrillation?
Cohort (n=224)
Does defining DOAC dose appropriateness by eGFR equations compared to the Cockcroft-Gault equation change the association with adverse events in older adults with atrial fibrillation?
In older adults with atrial fibrillation, eGFR equations are not inferior to the Cockcroft-Gault equation for defining DOAC dose appropriateness regarding the risk of adverse clinical events.
eGFR-based DOAC dosing yields similar event rates to Cockcroft-Gault in discrepant cases; leaves open whether equations are interchangeable for dosing in older AF.
Background The Cockcroft–Gault equation (CrClC-G) is recommended for dose adjustment of direct oral anticoagulant drugs (DOACs) to kidney function. We aimed to assess whether defining DOAC dose appropriateness according to various kidney function estimators changed the associations between dose appropriateness and adverse events in older adults with atrial fibrillation (AF). Methods Participants of the Berlin Initiative Study with AF and treated with DOACs were included. We investigated CrClC-G and estimated glomerular filtration rate (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration and European Kidney Function Consortium equations based on creatinine and/or cystatin C. Marginal structural Cox models yielded confounder-adjusted hazard ratios for the risk of mortality, thromboembolism and bleeding associated with dose status. Results A total of 224 patients were included in the analysis (median age 87 years). Using CrClC-G, 154 (69%) had an appropriate dose of DOACs, 52 (23%) were underdosed and 18 (8%) were overdosed. During a 39-month median follow-up period, 109 (14.9/100 person-years) participants died, 25 (3.6/100 person-years) experienced thromboembolism and 60 (9.8/100 person-years) experienced bleeding. Dose status was not associated with mortality and thromboembolism, independent of the equation. Underdose status was associated with a lower risk of bleeding with all the equations compared with the appropriate dose group. In participants with discrepancies in dose status using CrClC-G and eGFR equations, the occurrence of endpoints did not differ between participants having an appropriate dose using CrClC-G or eGFR. Conclusion In older adults with AF, the association of DOAC dose status with adverse events did not differ when using CrClC-G or eGFR. Our results suggest that eGFR equations are not inferior to CrClC-G within this context.
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Villain et al. (2023) conducted a cohort in Atrial fibrillation (n=224). DOAC dose appropriateness defined by eGFR equations vs. DOAC dose appropriateness defined by Cockcroft-Gault equation was evaluated on Mortality, thromboembolism, and bleeding. In older adults with atrial fibrillation, eGFR equations were not inferior to the Cockcroft-Gault equation for assessing DOAC dose appropriateness and its association with adverse events.
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